RT Journal Article
SR Electronic
T1 Surgical Management of Charcot Spinal Arthropathy in the Face of Possible Infection
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 8097
DO 10.14444/8097
A1 Alexander von Glinski
A1 Sven Frieler
A1 Christopher J. Elia
A1 Darius Ansari
A1 Clifford Pierre
A1 Basem Ishak
A1 Ronen Blecher
A1 Bilal Qutteineh
A1 Sarah Strot
A1 Rod J. Oskouian
A1 Jens R. Chapman
YR 2021
UL http://ijssurgery.com//content/early/2021/07/22/8097.abstract
AB Background The design is a retrospective cohort study. Charcot spinal arthropathy (CSA) is a rare and poorly understood progressive destructive spine condition that usually affects patients with preexisting spinal cord injury. The complexity of this condition, especially when additionally burdened by superimposed infection in the CSA zone, can potentially lead to suboptimal management such as protracted antibiotic therapy, predisposition to hardware failure, and pseudarthrosis. While in noninfected CSA primary stabilization is the major goal, staged surgical management has not been stratified based upon presence of a superinfected CSA. We compare clinical and radiological outcomes of surgical treatment in CSA patients with and without concurrent spinal infections.Methods Our single-institution database was reviewed for all patients diagnosed with CSA and surgically treated, who were subsequently divided into 2 cohorts: spinal arthropathy with superimposed infection and those without. Those were comparatively studied for complications and reoperation rate.Results Fifteen patients with CSA underwent surgical intervention; mean follow up of 15.3 months (range, 0–43). Eleven patients received stabilization with a quadruple-rod thoracolumbopelvic construct, while 4 patients with superinfected CSA underwent a staged procedure. Patients treated with a staged approach experienced fewer intraoperative complications (0% versus 18%) and fewer revision surgeries (25% versus 36%). Both cohorts had the same eventual healing.Conclusions Surgical management in CSA patients with primary emphasis on stability and modified surgical treatment based on presence of an active infection in the zone of neuropathic destruction will lead to similar eventual successful results with relatively few and manageable complications in this challenging patient population.Level of Evidence 4.Clinical Relevance The proposed treatment algorithm including the use of a quadruple-rod construct with lumbopelivic fixation and a staged approach in patients with superinfected CSA represents a reasonable option in the surgical treatment of CSA.